原发性肾病综合征合并甲状腺功能异常患者临床资料分析

Analysis of Clinical Data in Primary Nephrotic Syndrome Accompanied with Thyroid Dysfunction

分析原发性肾病综合征合并甲状腺功能异常患者的临床特征,探讨其临床意义。对37例原发性肾病综合征合并甲状腺功能异常患者的临床资料进行回顾性分析,治疗前检测甲状腺过氧化物酶抗体(Anti-TPO)、甲状腺球蛋白抗体(Anti-TG),并分别于治疗前后检测血清游离T3(FT3)、血清游离甲状腺激素(FT4)、促甲状腺激素(TSH)、及24小时尿蛋白量、血浆白蛋白、总胆固醇、甘油三酯。37例原发性肾病综合征合并甲状腺功能异常患者中,单纯FT3降低19例,占51.4%,单纯FT4降低7例,占18.9%,FT3降低及TSH升高伴Anti-TPO轻度升高2例,占5.4%;所分析患者中均无甲状腺功能减退的临床表现;血清FT3水平降低与24小时尿蛋白量呈负相关,与血浆白蛋白呈正相关,与总胆固醇、甘油三酯无明显相关性。原发性肾病综合征患者可出现FT3、FT4、TSH异常,且随病情改善而改善;甲状腺功能检测可能有助于判断原发性肾病综合征患者病情及预后。

To investigate the clinical significance , clinical features of patients with primary nephrotic syndrome accompanied with thyroid dysfunction were analysed. Thirty seven patients with primary nephrotic syndrome accompanied with thyroid dysfunction were se- lected in this retrospective study. Levels of FT3, FT4 ,TSH, 24h proteinuria quantitative, serum albumin, total cholesterol, triglyceride were detected before and after treatment , while Anti--TPO and Anti--TG were detected before treatment. Decreased level of FT3 was detected in 19 cases（51.4~）, decreased level of FT4 was detected in 7 cases （18. 9~） and decreased level of FT4 accompanied with increased levels of TSH and Anti--TPO occured in 2 cases（ 5.4 %）. None of the patients presented clinical manifestations of hypothyroidism. Serum level of FT3 was positively correlated with serum albumin but negatively correlated with urinary protein. No correlation was found between serum thyroid hormone levels and total cholesterol,triglyceride. Patients with primary nephrotic syndrome may be accompanied with abnormal FT3 , FT4 and TSH , which may be improved with relief of the disease. Measurement of serum thyroid hormone in nephrotic syndrome patients might be a predictor of the disease severity and prognosis.